Assesment finding for reye's syndrome:
- Stage 1 : lethargy, vomiting and hepatic dysfunction
- Stage 2 : hypervetilation, hyperactive reflexes, delirium and hepatic dysfunction.
- Stage 3 : coma, decorticate rigidity, hyperventilation and hepatic dysfunction.
- Stage 4 : deepening coma, large fixed pupils, decerebrate rigidity and minimal hepatic dysfunction.
- Stage 5 : seizures, flaccidity, loss of deep tendon reflexes and respiratory arrest (death is usually a result of cerebral edema or cardiac arrest).
Diagnostic evaluation for reye's syndrome :
- CSF analysis shows a WBC count less than 10/ul; with coma. there's increased CSF pressure.
- Blood test results show elevated serum ammonia levels; serum fatty acid and lactate levels are also increased.
- Liver biopsy show fatty droplets uniformly distributed throughout cells.
- Liver function studies show aspartate aminotransferase and alanine aminotransferase are elevated twice from normal levels.
- Coagulation studies reveal prolonged PT and PTT.
Treatment for reye's syndrome :
- Endotracheal intubation and mechanical ventilation to control partial pressure of arterial carbon dioxide levels.
- Induced hypothermia.
- Exchange transfusion.
- Decompressive craniotomy.
- Enteral or parenteral nutrition as needed.
- Transfusion of fresh frozen plasma.
Nursing diagnosis for reye's syndrome :
- Ineffective thermoregulation.
- Decreased intracranial adaptive capacity.
- Impaired physical mobility.
- Impaired gas exchange.
- Risk for fluid volume deficit.
- Risk for impaired skin integrity.
Nursing planning and goals for reye's syndrome :
- The patient will maintain adequate ventilation.
- The patient will maintain a normal respiratory status, as evidenced by normal respiratory rate.
- The patient will maintain orientation to environment without evidence of deficit.
- The patient will maintain skin integrity.
- The patient will maintain joint mobility and range of motion.
Nursing implementation for reye's syndrome :
- Monitor vital signs and pulse oximetry to determine oxygenation status.
- Monitor ICP with a subarachnoid screw or other invasive device to closely assess for increased ICP.
- Monitor blood glucose levels to detect hyperglycemia or hypoglycemia and to prevent complications.
- Monitor fluid intake and output to prevent fluid overload.
- Assess cardiac, respiratory and neurologic status to evaluate the effectiveness of interventions and monitor for complications such as seizures.
- Assess pulmonary artery catheter pressures to assess cardiopulmonary status.
- Keep the head of the bed at a 30 degree angle to decrease ICP and promotes venous return.
- Maintain seizures precautions to prevent injury.
- Maintain oxygen therapy, which may include intubation and mechanical ventilation, to promote oxygenation and maintain thermoregulation.
- Administer medications as ordered and monitor for adverse effects to detect complications.
- Administer blood products as necessary to increase oxygen-carrying of blood and to prevent hypovolemia.
- Check for loss of reflexes and signs of flaccidity to determine degree of neurologic involvement.
- Provide a hypothermia blanket as needed and monitor the client's temperature every 15 to 30 minute while the blanket is in use to prevent injury and maintain thermoregulation.
- Provide postoperative craniotomy care in necessary to promote wound healing and to prevent complications.
- Provide good skin and mouth care and perform ROM exercise to prevent alteration in skin integrity and to promote joint motility.
- Be supportive of the family and keep them informed of the patient status to decrease anxiety.
Evaluation for reye's syndrome :
- The patient returns to normal respiratory state without sign of respiratory distress.
- The patient will maintain joint mobility and range of motion as well as skin integrity during hospital course.
- The patient has minimal neurologic complication as ICP decreases, as evidenced by reflexes, LOC and orientation.
- The parent verbalize an understanding of avoiding this syndrome by using nonsalicylate analgesic and antypiretic.
Management Nursing Care Plans @ 2:14 AM,